Abstract
Objectives
To determine i) whether cases of elderly fallers had lower serum 25-hydroxyvitamin D (25OHD) concentration than controls without history of falls; and ii) whether serum 25OHD concentration was associated with specific mechanisms, circumstances and consequences of falls.
Design
Case-control study with a 1:2 ratio.
Setting
Geriatric ward of the University Hospital of Angers, France, between February 2012 and March 2014.
Participants
216 inpatients (72 cases and 144 age- and gender-matched controls).
Measurement
Falls were defined as involuntary events causing the person to the ground or other lower level. The main mechanisms, circumstances and consequences of falls were identified using standardized questionnaires. Vitamin D deficiency was defined as serum 25OHD concentration ≤25nmol/L. Age, gender, body mass index, polypharmacy, use antihypertensive drugs, use psychoactive drugs, disability, cognitive performance, serum concentrations of parathyroid hormone, creatinine and albumin, and season of evaluation were used as potential confounders.
Results
216 participants (72 cases and 144 controls) were included in the study. There was no between-group difference in the prevalence of vitamin D deficiency (P=0.176). After adjusting for confounding factors, vitamin D deficiency was positively associated with falls (OR=4.03, P=0.014). Finally, the fallers with vitamin D deficiency exhibited more often orthostatic hypotension (68.8% against 33.3%, P=0.039) and a history of recurrent falls (85% against 50%, P=0.002) than those without vitamin D deficiency.
Conclusion
This casecontrol study reported that vitamin D deficiency was associated with falls in older inpatients. There was a greater prevalence of orthostatic hypotension and of the reccurrence of falls among fallers with vitamin D deficiency, suggesting that vitamin D may influence the conditions predisposing to falls rather than the fall by itself.
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References
Beauchet O, Dubost V, Revel Delhom C, Berrut G, Belmin J; French Society of Geriatrics and Gerontology. How to manage recurrent falls in clinical practice: guidelines of the French Society of Geriatrics and Gerontology. J Nutr Health Aging 2011;15:79–84.
Freeman C, Todd C, Camilleri-Ferrante C, Laxton C, Murrell P, Palmer CR, Parker M, Payne B, Rushton N. Quality improvement for patients with hip fracture: experience from a multi-site audit. Qual Saf Health Care 2002;11:239–245.
Alekna V, Stukas R, Tamulaityte-Morozoviene I, Šurkiene G, Tamulaitiene M. Selfreported consequences and healthcare costs of falls among elderly women. Medicina 2015;51:57–62.
Bischoff-Ferrari HA, Dawson-Hughes B, Staehelin HB, Orav JE, Stuck AE, Theiler R, Wong JB, Egli A, Kiel DP, Henschkowski J. Fall prevention with supplemental and active forms of vitamin D: a meta-analysis of randomised controlled trials. BMJ 2009;339:3692.
Annweiler C, Schott AM, Berrut G, Fantino B, Beauchet O. Vitamin D-related changes in physical performance: a systematic review. J Nutr Health Aging 2009;13:893–898.
Annweiler C, Montero-Odasso M, Schott AM, Berrut G, Fantino B, Beauchet O. Fall prevention and vitamin D in the elderly: an overview of the key role of the non-bone effects. J Neuroeng Rehabil 2010;7:50.
Chapuy MC, Arlot ME, Duboeuf F, Brun J, Crouzet B, Arnaud S, Delmas PD, Meunier PJ. Vitamin D3 and calcium to prevent hip fracture in elderly women. N Engl J Med 1992;327:1637–1642.
Annweiler C, Beauchet O. Questioning vitamin D status of elderly fallers and nonfallers: a meta-analysis to address a ‘forgotten step’. J Intern Med 2015;277:16–44.
Law M, Withers H, Morris J, Anderson F. Vitamin D supplementation and the prevention of fractures and falls: results of a randomized trial in elderly people in residential accommodation. Age Ageing 2006;35:482–486.
Porthouse J, Cockayne S, King C, Saxon L, Steele E, Aspray T, Baverstock M, Birks Y, Dumville J, Francis R, Iglesias C, Puffer S, Sutcliffe A, Watt I, Torgerson DJ. Randomized controlled trial of calcium and supplementation with cholecalciferol (vitamin D3) for prevention of fractures in primary care. BMJ 2005;330:1–6.
Annweiler C, Schott AM, Rolland Y, Beauchet O. Vitamin D deficiency is associated with orthostatic hypotension in oldest-old women. J Intern Med 2014;276:285–295.
Duval GT, Brangier A, Barré J, Launay CP, Beauchet O, Annweiler C. Vitamin D Deficiency and Incident Onset of Orthostatic Hypotension in Older Adults: Preliminary Results from the ‘MERE’ Study. J Am Geriatr Soc 2015;63:1245–1247.
Ometto F, Stubbs B, Annweiler C, Duval GT, Jang W, Kim HT, McCarroll K, Cunningham C, Soysal P, Isik AT, Luchini C, Solmi M, Sergi G, Manzato E, Veronese N. Hypovitaminosis D and orthostatic hypotension: a systematic review and meta-analysis. J Hypertens 2016;34:1036–1043.
Annweiler C, Schott AM, Abellan van Kan G, Rolland Y, Blain H, Fantino B, Herrmann FR, Beauchet O. The Five-Times-Sit-to-Stand test, a marker of global cognitive functioning among community-dwelling older women. J Nutr Health Aging 2011;15:271–276.
Folstein MF, Folstein SE, McHugh PR. «Mini-mental state». A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189–198.
Launay CP, de Decker L, Kabeshova A, Annweiler C, Beauchet O. Screening for older emergency department inpatients at risk of prolonged hospital stay: the brief geriatric assessment tool. PLoS One 2014;9:e110135.
Aguilova L, Sauzéon H, Balland É, Consel C, N’Kaoua B. AGGIR scale: a contribution to specifying the needs of disabled elders. Rev Neurol 2014;170:216–221.
Stein MS, Wark JD, Scherer SC, Walton SL, Chick P, Di Carlantonio M, Zajac JD, Flicker L. Falls relate to vitamin D and parathyroid hormone in an Australian nursing home and hostel. J Am Geriatr Soc 1999;47:1195–1201.
Suzuki T, Kwon J, Kim H, Shimada H, Yoshida Y, Iwasa H, Yoshida H. Low serum 25-hydroxyvitamin D levels associated with falls among Japanese communitydwelling elderly. J Bone Miner Res 2008;23:1309–1317.
Snijder MB, van Schoor NM, Pluijm SM, van Dam RM, Visser M, Lips P. Vitamin D status in relation to one-year risk of recurrent falling in older men and women. J Clin Endocrinol Metab 2006;91:2980–2985.
Le Boff MS, Hawkes WG, Glowacki J, Yu-Yahiro J, Hurwitz S, Magaziner J. Vitamin D-deficiency and post-fracture changes in lower extremity function and falls in women with hip fractures. Osteoporos Int 2008;19:1283–1290.
Hosmer DW, Lemeshow S. Applied logistic regression. Wiley, New-York.
Yamamoto T, Kozawa O, Tanabe K, Akamatsu S, Matsuno H, Dohi S, Hirose H, Uematsu T. 1,25-dihydroxyvitamin D3 stimulates vascular endothelial growth factor release in aortic smooth muscle cells: role of p38 mitogen-activated protein kinase. Arch Biochem Biophys 2002;398:1–6.
Zehnder D, Bland R, Chana RS, Wheeler DC, Howie AJ, Williams MC, Stewart PM, Hewison M. Synthesis of 1,25-dihydroxyvitamin D(3) by human endothelial cells is regulated by inflammatory cytokines: a novel autocrine determinant of vascular cell adhesion. J Am Soc Nephrol 2002;13:621–629.
Somjen D, Weisman Y, Kohen F, Gayer B, Limor R, Sharon O, Jaccard N, Knoll E, Stern N. 25-hydroxyvitamin D3-1alpha-hydroxylase is expressed in human vascular smooth muscle cells and is upregulated by parathyroid hormone and estrogenic compounds. Circulation 2005;111:1666–1671.
Annweiler C, Schott AM, Berrut G, Chauviré V, Le Gall D, Inzitari M, Beauchet O. Vitamin D and ageing: neurological issues. Neuropsychobiology 2010;62:139–50.
Lee KJ, Lee YJ. Effects of vitamin D on blood pressure in patients with type 2 diabetes mellitus. Int J Clin Pharmacol Ther 2016;54:233–242.
Lv WS, Zhao WJ, Gong SL, Fang DD, Wang B, Fu ZJ, Yan SL, Wang YG. Serum 25-hydroxyvitamin D levels and peripheral neuropathy in patients with type 2 diabetes: a systematic review and meta-analysis. J Endocrinol Invest 2015;38:513–518.
Beauchet O, Annweiler C, Verghese J, Fantino B, Herrmann FR, Allali G. Biology of gait control: Vitamin D involvement. Neurology 2011;76:1617–1622.
Annweiler C, Dursun E, Féron F, Gezen-Ak D, Kalueff AV, Littlejohns T, Llewellyn DJ, Millet P, Scott T, Tucker KL, Yilmazer S, Beauchet O. ‘Vitamin D and cognition in older adults’: updated international recommendations. J Intern Med 2015;277:45–57.
Annweiler C, Montero-Odasso M, Llewellyn DJ, Richard-Devantoy S, Duque G, Beauchet O. Meta-analysis of memory and executive dysfunctions in relation to vitamin D. J Alzheimers Dis 2013;37:147–171.
Tromp AM, Smit JH, Deeg DJ, Bouter LM, Lips P. Predictors for falls and fractures in the Longitudinal Aging Study Amsterdam. J Bone Miner Res 1998;13:1932–1939.
King MB, Tinetti ME. Falls in community-dwelling older persons. J Am Geriatr Soc 1995;43:1146–1154.
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Duval, G.T., Paré, PY., Gautier, J. et al. Vitamin D and the mechanisms, circumstances and consequences of falls in older adults: A case-control study. J Nutr Health Aging 21, 1307–1313 (2017). https://doi.org/10.1007/s12603-016-0857-0
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DOI: https://doi.org/10.1007/s12603-016-0857-0